Coronavirus in Context: The Relationship Between Your Lungs and COVID-19

Hello. I'm Dr. John Whyte, chief medical officer at WebMD. And welcome to Coronavirus In Context. Today, we're going to talk about the relationship of coronavirus to our lungs.

And I'm delighted to be joined by Dr. Cedric Jamie Rutland. He is a pulmonary and critical care medicine physician. He is a national spokesperson for the American Lung Association. And he's an assistant clinical professor of internal medicine at the University of California Riverside School of Medicine. Dr. Rutland, thanks for joining me.

Thanks for having me today. Much appreciated.

We hear a lot about patients with lung disease are at increased risk for coronavirus. Why exactly do we need to be concerned if we have lung disease? How does COVID-19 impact the lungs?

You know, I think before we get into how COVID-19 impacts the lungs, we've got to get into just how the lung works. The lung essentially takes oxygen from the air and puts it in your bloodstream. And the way that it does that is it has a bunch of pipes. When you take a deep breath in -- this is the main pipe here, your trachea. That leads to a bunch of balloons stacked on top of one another.

You inflate the balloons. The lining of the balloon connect your bloodstream to the environment. Pulls the oxygen out, puts it in the bloodstream, and then you're able to develop energy and be yourself.

When you think about coronaviruses -- of which there are seven that infect the human -- the coronavirus actually binds to cells of those balloons. And when the coronavirus binds to cells of those balloons, it actually leads to the recruitment of inflammatory cells and fluid that fill up the balloon instead of air filling up the balloon. And the patient becomes much more short of breath because the balloon is full of other things than it's supposed to be full of, which is air.

Let's talk about some lung conditions because sometimes we'll use the word respiratory. People don't quite get that. Let's start with asthma. If you have asthma, are you at increased risk? Does it matter if it's mild asthma versus moderate? What's the role of asthma?

So that's a very interesting question. So remember how I had just explained that the lung is essentially pipes and balloons. Asthma is a disease of the pipes. So you get, you've got inflammation in the pipes, and so those pipes get really narrow. Now at times, when those pipes become too inflamed and they get aggravated, you start to wheeze and you get short of breath.

So I don't want to sit here and say to you that asthma is a extreme risk factor of developing coronavirus. But I will say that if your asthma is uncontrolled and you develop coronavirus or contract coronavirus, it can make your asthma that much worse. Because there are those same receptors on the bronchial epithelium, on those bronchials, which are the pipes. So it can lead to a worsening of your disease process overall.

You should be making sure you take your medicines. Perhaps those daily inhalers? Should you be using rescue inhalers more often? Any advice on patients with asthma?

Yeah I think, you know, it depends on how controlled your asthma is. If you're someone that uses the daily inhaler -- which consists of inhaled corticosteroids and a beta agonists. That's kind of a red inhaler or a purple inhaler, whichever one you have. Then, and you're controlled and you're not wheezing, you're probably OK. If you're someone that notices that the presence of a respiratory virus leads to you using your rescue inhaler more, then we need to step up your therapy and put you on that maintenance inhaler to calm down the inflammation.

What about COPD? How does that impact coronavirus?

Great question. So one of my pet peeves in medicine is that we throw around this term COPD. COPD actually encompasses two different illnesses. One is chronic bronchitis, which is inflammation of the pipes, right, as a result of smoking. And then the other is emphysema, which emphysema simply means dead lung.

So remember how I said the lung as a bunch of balloons. Emphysema is you just don't have any of those balloons, or you don't have as many balloons as you're supposed to have. And so that really affects your ability to perform a gas exchange. And so if you have any one of those conditions, yeah, it can put you at risk. Example, if you have emphysema, if you have a dead lung, and your lung gets inflamed or infected by the SARS coronavirus, you have less balloons to overcome that infection or that inflammation. And so it will make you that much more short of breath.

And so for my patients that have emphysema, I tell them, listen, if you have grandchildren, if you have kids around, babies around that are getting frequent respiratory infections, you need to protect yourself. You can't take a family away from their family. That's very difficult to do. But I do want them to take the necessary precautions to protect themselves -- that is, masking, gloves, great hand hygiene, and things of that sort.

Is shortness of breath a key component? You're knowledgeable on and the whole area of respiratory issues. We've been talking about shortness of breath. Is that when you should really get alarmed?

You know, when you get significant shortness of breath at home, and you cannot, you cannot deal with the symptoms at home -- like you're getting much more short of breath than you're used to getting -- yeah, you gotta visit the hospital. That becomes an issue because it may not be coronavirus that's causing your symptoms. It might be something else. But you're putting yourself at risk of being near someone that may have it, which can make you that much worse.

So what I have arranged, at least in my practice, is my patients already have my cell phone number. But they will call me or they will text me and let me know. Hey, these are the symptoms that I'm having. What do you think? And most of them will have a pulse oximeter so they can actually check their oxygen level.

I always tell patients they'll know shortness of breath when they have it. Because sometimes [AUDIO OUT] but it'll be hard to talk. It will be hard to move. What about patients with lung cancers, maybe even those that are lung cancer survivors? Do they need to be more concerned during this term?

Yeah. You know, that's such a great question. I was doing a question and answer session for the American Lung Association the other day and I got a lot of questions surrounding lung cancer.

So here is the way that I would think about that. When you have lung cancer, it depends on where you are in your treatment. If you are a person that is currently getting chemotherapy, yes, you're at risk. Right? Chemotherapy calms down your immune system. Doesn't allow your immune system to work as well and recruit as many cells. So your infection can kind of travel through your body unchecked.

If you are a person that had a surgery, and a significant portion of your lung is gone, again, that gives you less balloons. So if you get infected, you're going to be affected more.

If you're a person that had a stage one lung cancer, let's say -- stage one as in one spot and you can cut it out to get rid of it. If you cut it out, you get rid of it, depending on how much lung has actually gone will kind of tell you how many, how much reserve you actually have. And so it really depends on your staging, on your treatment, and what we've done for you up to that point. So I think it's important. If you have a lung cancer, speak to your physician or speak to your pulmonologist so that they can best protect you or tell you what's going on in the world and around you.

Now you've been talking about these receptors. And a lot of patients with lung disease have high blood pressure, hypertension. Some of them are on these medicines, as you know, called ACE inhibitors. And there's been some data that suggests that could be a problem based on how COVID-19 attacks the lungs. So what's your guidance if patients are on these ACE inhibitors, and they're at greater risk of coronavirus?

You know, that, that is such a great question. And I really, really think that it depends on timing in regards to those ACE inhibitors and those ARBs. And this is something that I study. And I hate to get too technical, but just to make it really simple.

If you have a cell, a lung cell that has a receptor on it -- say it's an ACE inhibitor.

OK. [LAUGHS]

OK? And then you have a virus that can bind to that receptor. Right? The virus can get into the cell by doing that. Now what these ACE inhibitors do is they actually inhibit that enzyme from working. So that ACE, so the angiotensin converting enzymes is what ACE stands for. That enzyme doesn't work. So if you inhibit that, what we're thinking is the body's going to try to counteract that by making more receptors.

So is it possible that by making more of these receptors, more virus can bind to it? That's one of the theories. Or in the acute setting, if you inhibit that receptor, are you actually inhibiting the virus's ability to bind? So those are the two things that go through our head. And what it, what it turns out, the way that we've determined what to do, is if somebody is on those medicines, we just continue them as we see fit.

M'kay.

I don't know if I would start somebody new. But just continue them as we see fit. Because again, hypertension can be damaging to your health.

What about vaping? Is vaping making coronavirus worse, putting you at greater risk?

Oh, I think 100%. So when you look at vaping -- you know, vaping is basically heat up a liquid that becomes a gas. And then that hot gas enters your lungs. When you look at the pathology of vaping, we know that it can injure the type two pneumocyte. Right? Which is the lung cell that supports the lung.

The virus binds to the type two pneumocyte. Right? And so you already have injury to the type to pneumocyte. So your lung isn't supported as much. And now you have a virus that's also binding to the healthy type two pneumocytes. So it can probably make you that much worse.

There has been no study to prove that together yet. But there have been studies that show where the coronavirus binds. And there have been studies that show that your type two pneumocyte is injured in E-VALI, or e-cigarettes or vaping acute lung injury.

So we know. Don't vape and don't smoke.

Correct.

Thank you, Dr. Rutland, for taking the time to chat with us today.

No problem. I appreciate you guys having me. You guys have a great day.

And I want to thank you for watching Coronavirus In Context. I'm Dr. John Whyte.